32 - Idiopathic Thrombocytopenic Purpura ( ITP ) Mcqs part 2

11q: In adolescents with new onset ITP , an antinuclear antibody test should be done to evaluate for ?
a. HIV
b. SLE
c. Kawasaki disease
d. Evan’s syndrome

answer b. SLE

12q: What is the test to be done in an ITP patient with unexplained anemia to rule out Evan’s syndrome?
a. ELISA
b. Coomb’s test
c. Blood smear
d. Bone marrow aspiration

answer b. coomb's test

13q: Differential diagnosis of ITP are ?
a. Exposure to medication that induces drug-dependent antibodies
b. Splenic sequestration due to previously unappreciated portal hypertension
c. Early aplastic processes such as fanconi anemia
d. Amegakaryocytic thrombocytopenia
e. Thrombocytopenia-absent radius ( TAR ) syndrome
f. All the above

answer f. all the above

14q: What is the disease that should be considered in young males found to have low platelet counts , particularly if there is a history of eczema and recurrent infection ?
a. SLE
b. HIV
c. Wiskott-aldrich syndrome
d. Hemolytic uremic syndrome

answer c. wiskott-aldrich syndrome

15q: All are true regarding the treatment of ITP except ?
a. There is no data showing that treatment affects either short- or long-term clinical outcome of ITP
b. Compared with untreated control subjects , treatment appears to be capable of inducing a more rapid rise in platelet count to the theoretically safe level of greater than 2 lakh/ cubic mm
c. Platelet transfusion in ITP is usually contraindicated unless life threatening bleeding is present
d. There is enough data to show that early therapy prevents intracranial hemorrhage

answer d. actually there is no data to show that early therapy prevents intracranial hemorrhage

16q: What is the best treatment for a case of ITP with minimal, mild or moderate symptoms ?
a. No therapy other than education and counselling of the family and patient
b. Intravenous immunoglobulin ( IVIG ) at a dose of 0.8-1.0 g/kg/day for 1-2 days
c. Intravenous anti-D therapy at a dose of 50-75 micrograms/kg
d. Prednisone at a dose of 1-4 mg/kg/24 hr

answer a. no therapy other than education and counselling of family and patient.

17q: What is the dose of IVIG given to a patient of ITP that induces a rapid rise in platelet count ( usually greater than 2 lakh/cubic mm ) in 95 % of patients with 48 hrs ?
a. 0.8-1.0 g/kg/day for 1-2 days
b. 1.0-1.5 g/kg/ day for 1-2 days
c. 0.8-1.0 g/kg/day for 4 days
d. 1.0-1.5 g/kg/day for 4 days

answer a. 0.8-1.0 g/kg/day for 1-2 days

18q: The role of splenectomy in ITP should be reserved for which of the following circumstances ?
a. The older child ( greater than or equal to 4 years of age ) with severe ITP that has lasted greater than 1 year ( chronic ITP ) and whose symptoms are not easily controlled with therapy
b. When life threatening hemorrhage ( intracranial hemorrhage ) complicated acute ITP, if the platelet count cannot be corrected rapidly with transfusion of platelets and administration of IVIG and corticosteroids
c. Both of the above
d. none of the above

answer c. both a and b

19q: In ITP , which is the primary site of both antiplatelet antibody synthesis and platelet destruction ?
a. Liver
b. Spleen
c. Gall bladder
d. pancreas

answer b. spleen

20q: All of the following are true about chronic ITP except ?
a. Approximately 50 % of patients who present with acute ITP have persistent thrombocytopenia for greater than 6 months and are said to have chronic ITP
b. Splenectomy is successful in inducing complete remission in 64-88 % of children with chronic ITP
c. Before splenectomy the child should receive pneumococcal and meningococcal vaccines
d. After splenectomy the child should receive pencillin prophylaxis

answer a. it is 20 % and not 50 % .

Essential Pediatric McQs
MCQs in Pediatrics 2nd edition
MCQs in Pediatrics ; Over 600 Questions with Explanatory Notes

31 - Idiopathic Thrombocytopenic Purpura ( ITP ) Mcqs part 1

1q: What is the most common cause of acute onset of thrombocytopenia in an otherwise well child ?
a. SLE
b. Wiskott-Aldrich syndrome
c. HIV
d. ( autoimmune )ITP

answer d. (autoimmune) ITP

2q: All of the following statements are true about Idiopathic Thrombocytopenic Purpura (ITP) except ?
a. A recent history of viral illness is described in 50-65% of cases of childhood ITP
b. Autoantibodies directed against the platelet surface develops
c. EBV related ITP is usually of short duration and HIV associated ITP is usually chronic
d. Splenomegaly is frequently seen

answer d. splenomegaly . It is rarely seen .

3q: Which of the following is a classical presentation of ITP ?
a. Previously healthy 1-4 year old child who has sudden onset of bleeding from gums and mucous membranes
b. Previously healthy 1-4 year old child who has sudden onset of generalized petechiae and purpura
c. Previously healthy 1-4 year old child presents with splenomegaly
d. Previously healthy 1-4 year old child presents with lymphadenopathy

answer b. child with sudden onset of generalized petechiae and purpura. Though bleeding from gums and mucous membranes is also frequently seen, petechiae and purpura is the classical presentation.

4q: What is the normal platelet count ?
a. 150 – 450 X 10 power 9 / Litre
b. 150 – 450 X 10 power 3 / cubic mm
c. Both a and b are true
d. None of them

answer c. Both a and b are true

5q: Thrombocytopenia refers to a reduction in platelet count to ?
a. Less than 1.5 lakh/cubic mm
b. Less than 2 lakh / cubic mm
c. Less than 1 lakh / cubic mm
d. Less than 2.5 lakh / cubic mm

answer a. less than 1.5 lakh /cubic mm

6q: In 70-80 % of children who present with acute ITP , spontaneous resolution occurs within ?
a. 3 months
b. 6 months
c. 9 months
d. 1 year

answer b. 6 months.

7q: All of the following are true about ITP except ?
a. Therapy does not appear to affect the natural history of the illness
b. Fewer than 1 % of patients have intracranial haemorrhage
c. 80 % of children who present with acute ITP go on to have chronic ITP
d. Severe thrombocytopenia ( platelet count less than 20 x 10 power 9 / litre ) is common

answer c. only 20 % go on to have chronic ITP and not 80 %

8q: Autoimmune hemolytic anemia and thrombocytopenia is otherwise called ?
a. Tourette’s syndrome
b. Evans syndrome
c. Capgras syndrome
d. None

answer b. Evan's syndrome

9q: All are true about acute ITP except ?
a. The hemoglobin value is normal or may be decreased if there have been profuse nosebleeds or menorrhagia
b. WBC count is decreased
c. Differential count is normal
d. Bone marrow examination shows normal granulocytic and erythrocytic series with characteristically normal or increased numbers of megakaryocytes
e. Platelet antibody testing is seldom useful in acute ITP

answer b. WBC count is normal and not decreased.

10q: What are the indications for bone marrow aspiration in ITP ?
a. An abnormal WBC count
b. An abnormal differential count
c. Unexplained anemia
d. Findings suggestive of bone marrow disease on history and physical examination
e. All the above

answer e. all the above